Worsening head bleeds in elderly blunt head trauma patients taking antithrombotics: Delayed CT head fails to change management

Background

Most elderly trauma patients suffer blunt head injury and many utilize antithrombotic (AT) medications. The utility of delayed CT-head (D-CTH) in neurologically intact elderly patients using AT who have an intracranial hemorrhage (ICH) on presentation is unknown. We hypothesized that D-CTH would not alter clinical management and aimed to evaluate the role of D-CTH in this population.

反复粪便培养金黄色葡萄球菌阳性老年患者口服万古霉素效果评价

目的 通过探讨肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者口服万古霉素的效果，为此类患者提供一种潜在的治疗方案。方法 前瞻性分析吉林大学第一医院干部病房2015 年9 月～2018 年12 月收治的186 例肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者。根据是否口服万古霉素治疗分为万古组和对照组。收集两组患者的一般临床资料，比较两组患者试验前后万古霉素血药浓度、血常规、降钙素原（PCT）、C 反应蛋白（CRP），试验期间粪便培养结果、体温、抗生素使用情况。结果 试验治疗期间，万古组便培养转阴率高于对照组，差异有统计学意义（P＜0.05）；万古组发热率（29.75%）低于对照组的34.77%，差异有高度统计学意义（P＜0.01）；万古组抗生素使用率（4.49%）低于对照组的19.23%，差异有高度统计学意义（P＜0.01）。试验前两组白细胞、中性粒细胞计数、中性粒细胞比例、PCT、CRP 比较，差异无统计学意义（P＞0.05）；试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP 低于对照组，差异有高度统计学意义（P＜0.01）。试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP 低于试验前，差异有高度统计学意义（P＜0.01）。结论 口服万古霉素可能提高肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者粪便转阴率，减少发热及抗生素的应用，降低炎症细胞水平，可能是此类患者一种潜在的临床治疗方案。     

Prevalence of and factors contributing to anxiety,depression and cognitive disorders among urban elderly in Odisha – A study through the health systems’ Lens

IntroductionGrowing geriatric mental health needs of urban population in India pose several programmatic challenges. This study aimed to assess anxiety, depression and cognitive disorders among urban elderly, and explore availability of social support mechanisms and of a responsive health system to implement the national mental health programme.Methods244 respondents were randomly selected from Berhampur city. We administered a semi-structured interview schedule to assess substance abuse, chronic morbidity, anxiety, depression and cognitive abilities. Further, in-depth interviews were conducted with 25 key informants including district officials, psychiatrists, and programme managers. We used R software and ‘thematic framework’ approach, respectively, for quantitative and qualitative data analysis. Ethical standards were complied with.ResultsAbout half of the respondents were economically dependent; 57.3% had moderate to severe anxiety; 46.7% had moderate to severe depression; while about 25% had severe cognitive impairments. We found association of chewing tobacco (1.34(0.28–2.40)) and depression (0.52(0.37–0.68)) with anxiety; negative perception about elderly-friendly society (1.64(0.75–2.53)) and physical inactivity (2.88(1.60–4.16)) with depression; and age (-0.11(-0.20 – -0.02)) and physical inactivity (-3.44(-5.13 – -1.74)) with cognitive disorders. Qualitative analysis revealed lack of awareness, social stigma, poor availability of trained human resources, and poor political commitment as important systemic barriers to early detection and treatment of mental ailments among the elderly.ConclusionEstablishing tobacco cessation centres, sensitizing community about mental health needs of elderly, incentivizing physical activity of elderly, integrating mental health with primary care, multi-skilling providers and developing a cadre of community counsellors need urgent attention of policy makers and programme implementers.     

超高龄老人髋部骨折的手术治疗

目的　探讨 80岁以上老年人髋部骨折围手术期处理经验。方法　对 4 6例 80岁以上老年人髋部骨折手术治疗方法及结果进行回顾性总结。结果　 4 6例患者均安全度过围手术期 ,手术优良率 89 7%。结论　对高龄患者要有充分认识和准备 ,大部分患者能接受手术治疗并获得优良效果     

Hemichorea associated with polycythaemia vera

Abstract Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in females and usually in generalised form. We present a 66-year-old woman with acute onset hemichorea-ballism with no vascular pathology in the basal ganglia region. A clear relationship was observed between the onset of chorea and worsening of haematological parameters in the patient. After repeated phlebotomies the patient's clinical status was improved. Polycythaemic chorea must be considered, especially in the elderly, as early diagnosis leads to effective treatment and prevention of complications.     

中青年脑梗死68例临床分析

脑梗死多见于老年人，但近年来中青年（16-45岁）患者逐渐增多且有年轻化趋势，深人探讨中青年脑梗死的致病因素及临床表现对其防治有重要意义。本文回顾性分析了我院自1998年1月到2004年12月问收治的中青年脑梗死患者68例，现报告如下。     

2 121例老年急性冠脉综合征患者血清脂类浓度的分析

目的分析60岁以上老年人血清脂类水平的参考值,并探讨急性冠脉综合征与血脂指标的相关性.方法将3 766例健康成人分为≤60岁和＞60岁的两个年龄段,采用生物化学的方法测量他们的血脂水平,找出60岁以上老年人的脂类参考值.同时分析2 121例老年急性冠脉综合征病人的脂类指标.结果 60岁以上老年人血脂参考值为:TC 4.65±1.96×1.05mmol/L;TG 1.02±1.96×0.45mmol/L;HDL-C 1.47±1.96×0.40mmol/L;LDL-C 2.98±1.96×0.56mmol/L;ApoA1 1.32±1.96×0.25g/L;ApoB 0.99±1.96×0.35g/L,并且急性心肌梗死和不稳定性心绞痛病人血清脂类各项指标之间没有显著性差异.结论血清LDL-C/HDL-C＞5和TG ≥1.9mmol/L这两项联合指标比其他单独指标与老年人急性冠脉综合征关系更密切.     

80例健康青年分别经针刺或艾灸肺俞穴后的肺功能变化

目的：探讨针刺与艾灸肺俞穴对健康人肺功能的影响。方法：我们选择了20－22岁健康男性80例，随机分为针刺组和艾灸组各40例，于针刺，艾灸前和针刺，艾灸后10min测试用力肺活量（FVC），用力呼气量（FEV1．0），最大呼气中段流速（MMF），最大呼气流量（PEFR），75％，50％，25％肺活量时的最大呼气流速（V75，V50，V25），结果：显示经针刺和艾灸肺俞穴后2组FVC，FFV1．0均显著增加，P＜0．05，2组间比较针刺组FVC明显高于艾灸组，P＜0．05，而且艾灸组MMF，V25亦显著降低P＜0．05，结论：健康人经针刺和艾灸肺俞穴后均可使大气道阻力减少，肺容量增加，提示一定量的艾燃烧后的烟雾可使健康人肺功能受到影响，使肺的小气道收缩，出现阻塞性改变。     

老年冠心病患者实施健康教育的远期效果分析

目的：探讨老年冠心病患者实施健康教育的远期效果。方法：110例老年冠心病患者被随机分为健康教育组（教育组）及对照组，每组各55例。在常规治疗的基础上教育组在住院期间及出院后4年内给予健康教育处方结合口头卫生宣教及科普板报知识等经常性的健康教育活动，而对照组不予健康教育。结果：教育组患者对冠心病知识的了解情况、饮食控制情况、规律服药治疗情况比对照组好（P＜0．01），出院后再次住院次数比对照组少（P＜0．01）。而情绪及吸烟量控制两组无显著性差异（P＞0．05）。结论：对老年冠心病患者实施经常性的健康教育是控制疾病恶化的重要措施。     

温州口岸出入境人员心房颤动分析

目的了解温州口岸出入境人员中的心房颤动的发生情况，探讨旅行保健方法。方法对检出的48例心房颤动患者的资料进行分析。结果对2003．11-2004．10从温州口岸出入境的19862名人员进行心电图检查，发现心房颤动病例48例，检出率为0．24％，其中男性29例，女性19例，男女之间检出率没有显著差异。心房颤动多见于老年人。结论出入境人员进行健康体检具有重要意义。确保出入境人员的健康。